Diabetic Ketoacidosis in Type 1 Diabetes Onset in Latin American Children.

OBJECTIVE: To describe the patterns of diabetic ketoacidosis (DKA) occurrence in children newly diagnosed with type 1 diabetes (T1DM) across several Latin American pediatric diabetes centers from 2018 to 2022. METHODS: A retrospective chart review included children under 18 with new-onset T1DM from 30 Latin American pediatric diabetes centers (Argentina, Chile, and Peru) between 30 December 2018 and 30 December 2022. Multiple logistic regression models examined the relationships between age, gender, medical insurance, BMI, and DKA at new-onset T1DM. As far as we know, there are no large studies in Latin American countries exploring the patterns of DKA in new-onset T1DM. RESULTS: A total of 2,026 (983 females) children, median age 9.12 (5.8 -11.7) years with new-onset-T1DM were included. Approximately 50% had no medical insurance. Mean glucose values were 467 mg/dL, pH 7.21, bicarbonate 13 mEq/L, HbA1c 11.3%, and BMI 18. The frequency of DKA was 1,229 (60.7%), out of which only 447 (36%) were severe. There was a significant decrease in the frequency of DKA as age increased: 373 (70.2%) in children under 6, 639 (61.6%) in those between 6 and 12, 217 and (47.5%) in those over 12. Children with medical insurance (58.8%) had a significantly lower frequency of DKA than those without (62.7%). The multiple logistic regression models showed that DKA was significantly and inversely associated with age [OR, 0.72 (95% CI 0.60-0.86)], BMI [OR, 0.95 (95% CI 0.92-0.99)], and medical insurance [OR, 0.75 (95% CI 0.60-0.94)] adjusted for sex. CONCLUSION: Latin American children with new-onset T1DM exhibited a substantial occurrence of DKA. Younger ages and the lack of medical insurance were significantly associated with DKA in new-onset T1DM.

Escorbuto en la adolescencia: reporte de un caso / Scurvy in adolescence: case report

El escorbuto es una enfermedad producida por déficit de vitamina C. Si bien en la actualidad es poco frecuente, la bibliografía describe grupos de riesgo en la población pediátrica, dentro de los que se encuentran los pacientes con alteraciones alimentarias. Se reporta el caso de un adolescente varón, de 11 años de edad, que desarrolló la enfermedad por un hábito alimentario selectivo, sin ingesta de frutas ni verduras. El objetivo del reporte es resaltar la importancia de la anamnesis alimentaria completa en la consulta con el equipo de salud, que permita sospechar y detectar de manera temprana y oportuna trastornos por déficit de micronutrientes como el escorbuto.

Scurvy is a disease caused by vitamin C deficiency. Although it is currently rare, risk groups in the pediatric population are described in the bibliography, including patients with eating disorders. We report the case of an 11-year-old male adolescent who developed the disease due to a selective eating habit, without fruits or vegetables. The objective of this report is to highlight the importance of complete food anamnesis in consultation with the health team, which allows to suspect and detect early and timely micronutrient deficiency disorders such as scurvy.

[Scurvy in adolescence: case report]. / Escorbuto en la adolescencia: reporte de un caso.

Scurvy is a disease caused by vitamin C deficiency. Although it is currently rare, risk groups in the pediatric population are described in the bibliography, including patients with eating disorders. We report the case of an 11-year-old male adolescent who developed the disease due to a selective eating habit, without fruits or vegetables. The objective of this report is to highlight the importance of complete food anamnesis in consultation with the health team, which allows to suspect and detect early and timely micronutrient deficiency disorders such as scurvy.

El escorbuto es una enfermedad producida por déficit de vitamina C. Si bien en la actualidad es poco frecuente, la bibliografía describe grupos de riesgo en la población pediátrica, dentro de los que se encuentran los pacientes con alteraciones alimentarias. Se reporta el caso de un adolescente varón, de 11 años de edad, que desarrolló la enfermedad por un hábito alimentario selectivo, sin ingesta de frutas ni verduras. El objetivo del reporte es resaltar la importancia de la anamnesis alimentaria completa en la consulta con el equipo de salud, que permita sospechar y detectar de manera temprana y oportuna trastornos por déficit de micronutrientes como el escorbuto. Palabras clave: escorbuto, vitamina C, deficiencia de ácido ascórbico, micronutrientes.

Diabetes materna y trastornos del neurodesarrollo en los hijos / Maternal diabetes and neurodevelopmental disorders in offspring

Resumen La diabetes durante el embarazo se asocia a un mayor riesgo perinatológico para los niños. Este puede reducirse significativamente con un control glucémico adecuado en estadios tempranos de la gestación. En la última década nuevos estudios han mostrado los efectos deletéreos de la diabetes materna en la salud de los hijos a largo plazo, como las alteraciones del neurodesarrollo y los efectos sobre el pronóstico educacional y ocupacional. Las mismas pueden ser clasificadas, desde el punto de vista clínico-diagnóstico en tres grupos principales: trastornos del aprendizaje y del desarrollo intelectual, trastorno por déficit de atención e hiperactividad y trastornos del espectro autista. El presente trabajo tiene como objetivo realizar una actualización no sistemática de la evidencia más reciente en el tema y comprender los mecanismos subyacentes que provocan el daño, con el fin de desarrollar estrategias preventivas.

Abstract Diabetes during pregnancy is associated with adverse effects on offspring perinatal outcomes. These could be reduced significantly with an adequate glycemic control in early stages of gestation. In the last decade, new studies have shown the effects of maternal diabetes in the long-term health of the offspring, like impaired neurodevelopment and its impact on educational and occupational outcome. This can be classified, from the clinical and diagnostic perspective, in three main groups: learning and cognitive disorders, attention deficit hyperactivity disorder and autism spectrum disorders. This paper has the objective to give a non-systematic upgrade of the current evidence on the subject, and to understand the underlying mechanisms of adverse neurodevelopmental outcomes which in turn may lead to strategies for its prevention.

[Maternal diabetes and neurodevelopmental disorders in offspring]. / Diabetes materna y trastornos del neurodesarrollo en los hijos.

Diabetes during pregnancy is associated with adverse effects on offspring perinatal outcomes. These could be reduced significantly with an adequate glycemic control in early stages of gestation. In the last decade, new studies have shown the effects of maternal diabetes in the long-term health of the offspring, like impaired neurodevelopment and its impact on educational and occupational outcome. This can be classified, from the clinical and diagnostic perspective, in three main groups: learning and cognitive disorders, attention deficit hyperactivity disorder and autism spectrum disorders. This paper has the objective to give a non-systematic upgrade of the current evidence on the subject, and to understand the underlying mechanisms of adverse neurodevelopmental outcomes which in turn may lead to strategies for its prevention.

La diabetes durante el embarazo se asocia a un mayor riesgo perinatológico para los niños. Este puede reducirse significativamente con un control glucémico adecuado en estadios tempranos de la gestación. En la última década nuevos estudios han mostrado los efectos deletéreos de la diabetes materna en la salud de los hijos a largo plazo, como las alteraciones del neurodesarrollo y los efectos sobre el pronóstico educacional y ocupacional. Las mismas pueden ser clasificadas, desde el punto de vista clínico-diagnóstico en tres grupos principales: trastornos del aprendizaje y del desarrollo intelectual, trastorno por déficit de atención e hiperactividad y trastornos del espectro autista. El presente trabajo tiene como objetivo realizar una actualización no sistemática de la evidencia más reciente en el tema y comprender los mecanismos subyacentes que provocan el daño, con el fin de desarrollar estrategias preventivas.

Infancia en movimiento / Childhood in movement

El cuerpo humano está diseñado para estar en movimiento. Como profesionales de la salud debemos promover un estilo de vida más activo en nuestros pacientes", menciona el Comité de Graduados de la Sociedad Argentina de Diabetes (SAD), en esta edición dedicada a la actividad física. Si de promoción de salud se trata, somos los pediatras, al intervenir en etapas tempranas de la vida, quienes más debemos comprometernos

Diabetes MODY: cuando la prevalencia es proporcional a la sospecha / Diabetes MODY: when the prevalence is proportional to suspicion

Comúnmente se divide a la diabetes mellitus en dos grandes grupos: tipo 1 y tipo 2, ambas con etiologías complejas en las que existe una interacción entre múltiples factores genéticos y ambientales

Clinical-etiologic correlation in children with Prader-Willi syndrome (PWS): an interdisciplinary study.

Prader-Willi syndrome (PWS) is a multisystemic disorder caused by the loss of expression of paternally transcribed genes within chromosome 15q11-q13. Most cases are due to paternal deletion of this region; the remaining cases result from maternal uniparental disomy (UPD) and imprinting defects. To better understand the phenotypic variability of PWS, a genotype-phenotype correlation study was performed in 91 children with PWS. Patients were diagnosed by Southern Blot Methylation assay and genetic subtypes were established using FISH and microsatellite analyses. Fifty-nine subjects with deletion (31/28 males/females; mean age 3.86 years), 30 with UPD (14/16 males/females; mean age 3.89 years) and 2 girls with a presumed imprinting defect (mean age 0.43 yrs) were identified. For correlation purposes patients were grouped as "deleted" and "non-deleted." An increased maternal age was found in the UPD group. Four of Holm's criteria were more frequently present in the deleted group: need for special feeding techniques, sleep disturbance, hypopigmentation, and speech articulation defects. Concerning cognitive assessments, only 9.52% of subjects with deletion had Full-Scale IQ (FSIQ) > or =70, while 61.53% of subjects without deletion had FSIQ > or =70. Similar results were found in behavioral measures. Sleep disorders and carbohydrate metabolism were systematically assessed. Polysomnoghaphic studies revealed a higher frequency of central events with desaturations > or =10% in the deleted group (P = 0.020). In summary, the phenotype was significantly different between both groups in certain parameters related to the CNS. These results might be related to the differences in brain gene expression of the genetic subtypes.

Cytotoxic T lymphocyte antigen 4 heterozygous codon 49 A/G dimorphism is associated to latent autoimmune diabetes in adults (LADA).

Autoimmune diabetes is an organ specific and multifactorial disorder with a classical onset as insulin dependent diabetes mellitus (IDDM) and with another form of onset as latent autoimmune diabetes in adults (LADA), which has a slower onset and a later progress to insulin dependency as a result of the beta cells destruction. The cytotoxic T lymphocyte-antigen 4 (CTLA4) has been identified as a susceptible marker of the disease; it is considered a down regulator of T cell function, playing a key role in autoimmunity. We analyzed CTLA4 codon 49 A/G polymorphism in 123 IDDM patients, 63 LADA patients and 168 healthy non-diabetic control individuals. The frequency of the heterozygous A/G genotype in LADA patients was significantly increased compared to IDDM patients (55.6 vs. 39.8%, p = 0.0415). There was no statistical significant difference in the distribution of the A/G dimorphism between autoimmune diabetes patients (LADA or IDDM) and non-diabetic control individuals. HLA DQ region is responsible for the genetic susceptibility to autoimmune diabetes in IDDM patients in about 50% and it has a lower effect in genetic susceptibility in LADA patients. Several other genetic loci are needed to develop autoimmune diabetes in adult patients. Therefore, LADA may be the result of a combined minor risk loci effect in a major risk haplotype.